Evidence-Based Practice in Psychology Bringing science into your practice

“The pure and the applied sciences advance in a single front.” Lightner Witmer (1906)

1

Evidence-Based Practice “…the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Sacket et al. (1996), on evidence-based medicine

EBP in Psychology

Task Force on Promotion and Dissemination of Psychological Procedures (1993)

2

EBP in Psychology

Task Force on Promotion and Dissemination of Psychological Procedures (1993)

EBP in Psychology •

The evidence base for any psychological intervention should be based on

1. Efficacy – Establishment of a causal relationship between interventions and disorders under treatment

2. Clinical utility / effectiveness – Consensus regarding generalizability, feasibility, and costs and benefits of an intervention APA (1995)

3

EBP in Psychology • Starting in 1996, updates regarding empirically supported treatments (ESTs) were published • Outlined treatments that had empirical support based on RCTs that used a treatment manual with a specific population • Goal was to identify treatments with support comparable to medications Chambless et al. (1996, 1998)

EST Examples • • • • • • • •

CBT for panic disorder CBT for generalized anxiety ERP for obsessive-compulsive disorder Cognitive therapy for depression IPT for depression PMT for child oppositional behavior CBT for bulimia CBT for chronic pain Chambless et al. (1996)

4

EBP in Psychology • Response to the Chambless report was varied • While it raised awareness of efficacy of psychological treatments… • …some decried emphasis on manualized, brief treatments and lack of emphasis on common therapeutic factors • Many divisions of APA and others (e.g., SBM) undertook internal studies of EBPP

EBPP Examined •

In 2006, APA Presidential Task Force on Evidence-Based Practice issued guidelines that

1. Described commitment to EBP in the field of psychology via integration of applied and basic research 2. Tries to take into account the myriad of ways that treatments and therapies can provide evidence of their efficacy

APA (2006)

5

Operational Definitions • EBPP is “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” • Purpose of EBPP is “to promote effective psychological practice and enhance public by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention.” APA (2006)

EBPP vs. ESTs • ESTs start with a treatment and ask if it works for a population • EBPP starts with patient and asks what is the best evidence for what will help to achieve a particular outcome • ESTs are specific psychological treatments, EBPP is a method of decision making APA (2006)

6

The Big Picture • Large body of research on children, adults, and seniors finding that therapy – – – –

Is safe and effective for these groups Can impact a wide range of problems Is more enduring in impact than medications Pays for itself in terms of medical cost offset, increased productivity, and QoL

Lambert & Ogles (2003)

The Big Picture • Meta-analyses have shown that – Most practices in widespread use are efficacious – Effect sizes equal or surpass those of medical treatments that are widely accepted

• Not all types of therapies have been subjected to RCTs, but this does not rule out their possible effectiveness Lambert & Ogles (2003)

7

The Big Picture There are effective therapies for Depression (ES of .56-2.15) Anxiety (ES of .51-3.32) Obesity (ES of .26) Anger (ES of .64-.82) Hypertension (ES of .65) Bulimia (ES of 1.28) • And many, many others… Lambert & Ogles (2003)

Now Know This •

The EBPP practitioner should be aware of

1. The strengths and limitations of each type of research 2. Factors found to impact therapy – – – –

Treatment method Individual psychologist Treatment relationship The patient APA (2006)

8

Now Know This •

“Local clinical scientist” should be the model for psychologist practicing EBPP

1. Integrates scientific findings and clinical expertise to form and test hypotheses about client problems and best treatment options 2. Is also aware of limitations, both in expertise and possible biases Stricker & Trierweiler (1995)

Components of Clinical Expertise • Assessment, diagnostic judgment, case formulation, and treatment planning • Clinical decision making, treatment planning, and monitoring progress • Interpersonal expertise • Continual self-reflection and skill acquisition APA (2006)

9

Components of Clinical Expertise • Evaluation and use of research evidence • Understanding impact of individual, cultural, and contextual differences • Seeking additional resources as needed • Cogent rationale for clinical strategies

Conclusions • EBPP should not be seen as a threat to those who do not currently practice it • Instead, it is a way to enhance delivery of services in atmosphere of respect, communication, and collaboration between – Practitioners – Researchers – Patients APA (2006)

10

Questions?

References •

APA Division 12. (1993). Task Force on Promotion and Dissemination of Psychological Procedures.

•

Chambless, D.L., et al. (1996). An update on empirically validated therapies. The Clinical Psychologist, 49(2), 5-18.

•

Chambless, D.L., et al. (1998). Update on empirically validated therapies, II. The Clinical Psychologist, 51(1), 3-16.

•

Sanderson, W.C. & Woody, S. (1995). Manuals for empirically validated treatments. The Clinical Psychologist, 48(4), 7-11.

•

Woddy, S.R., & Sanderson, W.C. (1998). Manuals for empirically supported treatments: 1998 update. The Clinical Psychologist, 51(1), 8-19.

•All available online at http://www.apa.org/divisions/div12/journals.html#ESTs

11

References •

APA Presidential Task Force on Evidence-Based Practice. (2006). Evidencebased practice in psychology. American Psychologist, 61, 271-285.

•

Lambert, M.J., & Ogles, B.M. (2003). The efficacy and effectiveness of psychotherapy. In Lambert (Ed.), Garfield & Bergin’s Handbook of Psychotherapy and Behavior Change, pp. 139-193.

•

Sacket, D.L. et al. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71-72.

•

Stricker, G., & Trierweiler, S.J. (1995). The local clinical scientist: A bridge between practice and research. American Psychologist, 50, 995-1002.

•

Witmer, L. (1996). Clinical psychology. American Psychologist, 51, 248-251. (Original work published in 1907)

12